Durable clinical benefit with exemestane in leptomeningeal metastasis of breast cancer

Martín, Luis Miguel Navarro; Fernandez, A. Ocana; Sánchez, César A. Rodríguez; Martin, Isabel Ruiz; Hernández, Juan Jesús Cruz

doi:10.1007/bf02716553

Cited by 18 publications

(7 citation statements)

References 15 publications

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“…In this review we have gathered data showing that subsets of patients have almost double the median OS in BC-LMD [ 12 , 45 ] and that use of ET in LMD can achieve prolonged survival rates compared with the usual reported outcomes [ 46 , 47 , 58–64 , 74 ]. Our statistical comparison showed significant differences between OS_LMD, suggesting that risk stratification could help identifying the most suitable patients for ET.…”

Section: Discussionmentioning

confidence: 99%

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

et al. 2020

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Leptomeningeal disease (LMD) represents a devastating complication of advanced breast cancer (ABC), with survival of <5 months with multimodal treatment. The role of endocrine therapy (ET), due to its favorable toxicity profile and first-line indication in luminal ABC, appears promising in the setting of LMD, where symptom stabilization and quality-of-life preservation are the main goals; however, evidenced-based data are lacking. We conducted a thorough review of published evidence, aiming to investigate the role of ET in LMD treatment in luminal ABC. Twenty-one of 342 articles, evaluating 1302 patients, met inclusion criteria. ET use was rarely reported. New targeted agents show CNS activity. Research is lacking on the role of ET and targeted agents in BC-LMD treatment.

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Section: Discussionmentioning

confidence: 99%

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

et al. 2020

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“…Treatment for patients with HER2 -BM For the treatment of patients with ER + /HER2 -BCBM, some responses have been observed with tamoxifen, 85 aromatase inhibitors 86,87 and fulvestrant 88 , and therefore, in the absence of therapeutic alternatives, these low-toxicity treatments have a place in paucisymptomatic ER + patients.…”

Section: Trastuzumab-based Regimens For Patients With Her2 + Bmmentioning

confidence: 99%

Treatment strategies for breast cancer brain metastases

2020

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Brain metastases from breast cancer (BCBM) constitute the second most common cause of brain metastasis (BM), and the incidence of these frequently lethal lesions is currently increasing, following better systemic treatment. Patients with ER-negative and HER2positive metastatic breast cancer (BC) are the most likely to develop BM, but if this diagnosis remains associated with a worse prognosis, long survival is now common for patients with HER2-positive BC. BCBM represents a therapeutic challenge that needs a coordinated treatment strategy along international guidelines. Surgery has always to be considered when feasible. It is now well established that stereotaxic radiosurgery allows for equivalent control and less-cognitive toxicities than whole-brain radiation therapy, which should be delayed as much as possible. Medical treatment for BCBM is currently a rapidly evolving field. It has been shown that the blood-brain barrier (BBB) is often impaired in macroscopic BM, and several chemotherapy regimens, antibody-drug conjugates and tyrosine-kinase inhibitors have been shown to be active on BCBM and can be part of the global treatment strategy. This paper provides an overview of the therapeutic option for BCBM that is currently available and outlines potential new approaches for tackling these deadly secondary tumours.

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“…Niwińska et al published an investigation of prognostic factors in LM, and 75% of the patients who had prolonged survival were treated with IT chemotherapy [7]. However, IT chemotherapy requires invasive procedures and has a higher treatment complication rate [8, 9], and it can often make a difficult situation worse [10]. Thus, IT chemotherapy has been administered less recently.…”

Section: Discussionmentioning

confidence: 99%

“…There are several published reports of successful treatment of LM with hormone therapies such as tamoxifen, letrozole, and exemestane [2, 5, 6, 8, 14–16]. Tamoxifen is a selective estrogen receptor modulator that is a highly lipophilic agent and can presumably cross the BBB easily [7].…”

Section: Discussionmentioning

confidence: 99%

Durable clinical benefit of letrozole in leptomeningeal metastasis of breast cancer

et al. 2019

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A case of a woman in her 60s with breast cancer, whose leptomeningeal metastasis (LM) of breast cancer improved remarkably with letrozole monotherapy, is reported. The patient complained of numbness of her left hand and hoarseness, followed by progressive asymmetric extremity weakness and a bladder and rectal disturbance. The patient had undergone surgery for left breast cancer 18 years earlier and was concerned about recurrence of breast cancer, but there were no typical findings with some imaging modalities. The third lumbar puncture showed the malignant cytology of breast cancer, and the patient was diagnosed with recurrent breast cancer. Her performance status was very poor, and it was difficult to administer systemic chemotherapy. Letrozole was started because immunohistochemistry was positive for estrogen and progesterone receptors. After 4 months of letrozole therapy, the symptoms improved gradually. LM has a poor prognosis, and there is little evidence on which to base treatment, but hormone therapy may be an option for LM when the tumor is hormone receptor-positive, slow growing, and has a small volume.

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Durable clinical benefit with exemestane in leptomeningeal metastasis of breast cancer

Cited by 18 publications

References 15 publications

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

Treatment strategies for breast cancer brain metastases

Durable clinical benefit of letrozole in leptomeningeal metastasis of breast cancer

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